Provider Demographics
NPI:1053742908
Name:HORTON, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ROYAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2040
Mailing Address - Country:US
Mailing Address - Phone:616-970-4172
Mailing Address - Fax:616-965-8929
Practice Address - Street 1:201 ROYAL PARK DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2040
Practice Address - Country:US
Practice Address - Phone:616-970-4172
Practice Address - Fax:616-965-8929
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-13-14538103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst